Impact of restructuring an inpatient pediatric service on length of stay and patient flow.

OBJECTIVES: To determine the impact of implementing a new pediatric inpatient structure - the clinical teaching unit (CTU) - on length of stay (LOS) and other patient care outcomes. METHODS: A retrospective study was carried out on children admitted to the General Pediatric Inpatient Service at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, between July 2015 and December 2018. The main outcome measures were median and mean LOS before and after CTU implementation. Other outcomes measured were the proportion of patients discharged on weekends, during daytime, and within 24 hours of admission, and the proportion of patients readmitted within 7 days of discharge. RESULTS: Median LOS decreased from 2.80 to 2.63 days after CTU implementation (p<0.0001). The proportion of weekend discharges significantly increased after CTU implementation from 18% to 21.5% (p<0.0243) and daytime discharges significantly increased from 6.9% to 25.6% (p<0.0001) after CTU implementation. The improvements in LOS were sustained in the years after CTU implementation, with median LOS decreasing from 2.71 to 2.60 days during 2016-2018 (p<0.001) and mean LOS decreasing from 5.03 to 3.92 days (p=0.0031). During the same period, readmission rates remained stable at 3.5-4%. CONCLUSION: The implementation of a new pediatric inpatient team structure led to significant improvements in many patient care outcomes, including decreased LOS.

The Association of Corticosteroid Therapy With Mortality and Length of Stay Among Children With Septic Shock: A Retrospective Cohort Study.

Introduction Septic shock remains a leading cause of mortality in pediatric patients. Corticosteroids have been used in the management of sepsis and septic shock, but there is conflicting evidence on the potential benefit of corticosteroid therapy. This study assessed the risk of mortality and length of stay in the pediatric intensive care unit (PICU) among pediatric patients admitted with a septic shock diagnosis. Method A retrospective cohort study was conducted among pediatric patients (up to 14 years old) admitted with a septic shock diagnosis to the PICU of King Abdullah Specialist Children's Hospital in Riyadh from January 2016 to December 2021. The clinical outcomes of patients receiving corticosteroid therapy were compared to those of control patients who were not given corticosteroids. Electronic medical records provided clinical data, severity scores, and the management given for each patient. The patients were followed up from the date of sepsis diagnosis to hospital discharge. Proportional hazard ratios (HRs) were calculated to compare the risk of mortality, length of PICU stay, and length of hospital stay. Results A total of 182 pediatric patients were included in the study, and 86 (47%) received corticosteroid therapy. The median age of the study population was 15 months (interquartile range [IQR]: 2-72 months). Compared to the controls, the patients who received corticosteroids had a higher total Sequential Organ Failure Assessment (SOFA) score (mean±SD: 5.5±3 vs. 7.1±3.3, respectively; p <0.01) and required more ventilation support (72% vs. 28%, respectively) and the use of inotropes and vasopressors (74% vs. 34% and 32% vs. 6%, respectively). In-hospital mortality did not significantly differ between the groups (adjusted HR: 2.66; 95% confidence interval [CI]: 0.66-10.28). Those patients who received corticosteroids had 42% less risk of staying in the PICU for over six days than those not receiving steroids (HR: 0.35; 95% CI: 0.13-0.98) Conclusion After adjusting for baseline characteristics, severity scores, and medical intervention, no association was found between receiving corticosteroids and mortality (p=0.492). Furthermore, patients who received corticosteroids had less risk of a prolonged stay in the PICU than those who did not.